In 2007, the cost of treating arthritis was more than 15 billion dollars; the overall cost in lost productivity was 150 billion. It is estimated that in an average family, a diagnosis of arthritis in the primary wage-earner will lead to a 50% drop in income over the first 10 years.

Source:Arthritis Insight

The Level of Inflammation in RA Remains Stable

A study conducted by the National Data Bank for Rheumatic Disease-Arthritis Research Center Foundation, has determined that the level of inflammation in rheumatoid arthritis is determined early and remains stable over the longterm course of the illness.

Over ten years, the erythrocyte sedimentation rate (ESR) was analyzed to measure inflammatory activity in 1,897 patients with RA. Scientists found that the ESR decreased by 4 mm/h over the first 10 years of disease, remained stable over the next 25 years, and increased slightly thereafter.

This is disappointing since earlier theories suggested that RA tended to “burn out” or lessen in severity over the years. However, the good new is that the very recently diagnosed who were receiving combination therapies did show marked improvement in symptoms, rather than remaining stable.

RA is a “New” Disease

Contrary to earlier reports, rheumatoid arthritis is a “new” disease, not described until the mid-1700’s. There have been many reports that RA existed in ancient times, but there is no scientific evidence that the disease existed in ancient Europe, Asia or Africa.

However, in Alabama, six skeletons of Native Americans–3,000 to 5,000 years old–show changes typical of RA. Scientists believe that some infectious agent was introduced and confined to a small geographic area before 1700’s.

Why is this important? If RA did appear recently, that suggests some environmental change could have triggered RA because the human gene structure has not changed in the last 250 years.

In November 1993, my husband, Bob, and I had come down with a really nasty case of the flu. Flu season was bad that year. We were supposed to go down to Kennewick, Washington for Thanksgiving to see my sister and her family. We didn’t make it.

Bob and I got over the flu. Or so I thought. Well, the good news is that at least Bob got well. But I was not so lucky. I kept getting sick.

At the time I was working as a janitor with a large janitorial firm here in Spokane. It was a union job and I was fortunate enough to have health insurance, which was with Group Health Northwest. Yes, a large HMO.

I wasn’t just having flu like symptoms. I had severe breathing difficulty. Fortunately, it wasn’t bad enough to require oxygen. There was also excess mucous from my lungs. It had gotten to the point that I’d be in the bathroom, violently heaving this stuff up from my lungs. My lungs were a little sore afterwards but I was breathing easier. What was hard for me was going to bed and waking up the next morning to find it covering my face and even some in my hair. I literally had to wash my hair daily, which wasn’t easy. You see, I had a bathtub, no shower, and thick curly black hair that was and still is shoulder length. Being sick my tail dragged all the time always fatigued. I had this feeling that I was really ill. This wasn’t going to just ‘go away quietly’. I just knew something was seriously wrong. There was an eerie uncommon feel to it.

I finally got sick and tired of being sick and tired. I made an appointment with Dr. Sayers, who was my primary care physician, after two months of the on again off again illness. I told him exactly what was going. I told him everything. After a blood test and a chest x-ray, I was informed that it was bronchitis. I never had bronchitis before so this was a first for me. He prescribed an antibiotic for me.

Well, the bronchitis continued to reoccur. And everything time it did, I would go back to Dr. Sayers, only to get the same prognosis. One occasion, Dr. Sayers informs that I have the bronchitis but my asthma was flaring up as well. He continues very rudely with “You really should have told us about that asthma thing.” Naturally, my response was “I don’t have asthma and I’ve never had asthma. Are you sure?” I was really getting scared at this point. I had been dealing with this for almost two years at this point.

Dr. Sayers lit into me about it. Some of you have probably been subjected to the song and dance routine that a small minority of doctors dish out about how they’re the doctors and had the eight year of college. “Doctor knows best.”

Needless to say, I went off on him. I lit into with both barrels blazing. My response was that I wanted a second opinion like now, if I didn’t get it I’d go over his head and he had better not talk to me in that manner ever again because I absolutely did not have any qualms about turning his butt in to the administration and escorting him out of the building via the third floor window in the exam room I just so happened to be in. Evidently he believed me because by the end of the week Dr. Noble’s nurse called me to schedule for an appointment.

Well, she (Dr. Noble) was a major improvement. She’s a doctor in internal medicine at Group Health. Really nice lady and seemed to know what she was talking about. She had reviewed my file and we had talked about what was going.

Some of the things that we had talked about included anything that might run in the family, Cystic Fibrosis, and other possibilities like Tuberculosis and Cancer. She had ordered another chest x-ray and blood work, including an A.C.E. level. The test for the A.C.E. level is to find out if it is present and how high that level is, because it’s present, from what I understand, shouldn’t be higher than 50. Dr. Noble called me with the results. Mine was over 100. She suspected a disease called sarcoidosis. That’s pronounced the way it looks. (Sar coy DOH sis.)

Dr. Noble set me up with a referral to a doctor in pulmonology at Rockwood Clinic. I met with Dr. Byrd in December of 1995 for the first time. He’s a sweet, older man who looks like someone’s grandfather as well as a doctor. I like him a lot, even though he shoved a tube down my nose. We setup a time for me to go the hospital as an outpatient for a bronchoscope. What they did was gave the medication in a nebulizer, which is one of those long blue tubes that are used for breathing treatments. This medication was to freeze up my throat. It caused me to cough badly, though. I was also given an anesthetic to put me to sleep. While I was out cold, they put a tube in my nose and put in to my lungs so they could tissue to biopsy.

The next thing that I remember is starting to wake up while the orderly was wheeling me on the gurney to the recovery area. When I fully came out of the anesthesia, I was allowed to go home. I got home via Spokane Transit Authority. I took a bus.

My next doctor’s appointment with Dr. Byrd was in January 1996. I was told at that point that I did have sarcoidosis. He started me on 40-mg prednisone daily. We’ve been gradually decreasing over the years. Currently I take 1 (10-mg) tablet daily. I am also taking other medications for asthma and high blood pressure. But I guess that other than that, I am okay. At least I am still among the living.

Quite a bit of time has passed since I was diagnosed. And a lot has happened since. I am thankful for the support I’ve had. Some people aren’t so lucky.

I keep trying to have a positive and most ofthe time it isn’t hard. But that doesn’t mean that there aren’t down moments. It is possible to live with this.

Weight training is healthful, fun, and productive. You don’t have to be a gym member to gain the benefits of this great activity. How much space you have, how much time you want to put into it, your training experience, and your goals influence how you set up your home workout area.

Let’s take a look at some options.

Do you have limited space? The easiest thing is to use your body weight for resistance. These exercises are called calisthenics. Calisthenics are great for beginners and can be used, to some extent, by advanced trainees. The problem is that there will always be a limit to how far you can go, unless you do something to increase the resistance beyond your weight by wearing weighted vests, hanging weights from your waist for pull-ups, or other devices. Special elastic bands can be used for resistance, and there are some available that can be used for, say, heavy squats. The force applied from elastic bands is not the same as with free weights; the force is always greatest when the band is stretched the most, which does not often match the normal strength curve. You may have to do the exercise from several positions to get the muscle worked evenly. And for some of us, bands are unsatisfactory because we like to be able to quantify how much we are lifting more precisely. It is usually more satisfying to progress from 15 to 20 lb dumbbells than to go from, say, a green band to a purple one.

Most people eventually will want to set up their own workout space and purchase some equipment. Free weights, which are dumbbells and barbells, can comprise all of the equipment you use, or can be used to complement weight training machines.

Dumbbells are inexpensive and don’t take up much room. They are easy to control and less likely than a barbell to knock a hole in your wall if you live in a small apartment. You may see recommendations to use something like a plastic milk jug filled with water or sand as a do-it-yourself alternative, but dumbbells are more comfortable to work with. You can get the inexpensive kind for home use. The fancy chrome ones hold up better to gym use, but you don’t need them. Get at least two sets to start with. Sedentary women may want to get 5 and 8 pounds, while older or out-of-shape males can start with maybe 12 and 15. Try them out on a bicep curl. Find a weight that fatigues you at about 10 repetitions, then get a pair of those and a pair of the next lightest ones. There is no maximum weight.

As you get stronger, you will want to get heavier dumbbells. You may want to get some weight plates and adjustable dumbbells, which consist of a handle that you load with weights of different sizes. This is cheaper and takes less space than getting a lot of dumbbells, especially when you are ready for the heavy ones. Another approach is to get a set of stacking dumbbells, such as PowerBlocks. These are more expensive, but are worth it, if you can afford it. I urge you to get a workout bench. If you are just going to use dumbbells, you can get one without barbell supports. There are many exercises you can do without a bench, but when you start doing heavier workouts, a workout bench allows you more comfort and versatility, and will be safer than that wobbly piano bench you may think you want to start out on.

Barbells are a nice addition. They allow you to do some heavier exercises, call for a different sort of muscular coordination than dumbbells, and have a certain mystique. Many advanced weight trainees have started with the inexpensive 110-pound weight set. If your space is really tight, you can get by with just dumbbells.

You may want to get your own weight training machine. Most home trainees who get machines get one multi-purpose piece of equipment, but if you have the space you can get more. There are too many choices to describe in detail, but a few generalities are in order. This is one case where you get what you pay for. A more expensive piece will give you more options, work more smoothly and comfortably, and hold up better. You may be able to get by with a less expensive option if you are not going to use it much, but if it is going to get much use, or be used by an advanced exerciser or a heavier person, it will be worth spending more. Conventional weight machines use stacks of weights, with the resistance usually controlled by a pin inserted in the stack. These are tried and true and feel most like gym machines, but are quite heavy. Some of the expensive ones are very well made and versatile, and some of the cheap ones are rough and require constant maintenance. Make sure you try out all the exercises while you’re in the store comparing models. Have the salesperson show you the adjustments and try them out yourself to make sure the machine fits you. If it is uncomfortable or causes pain when you use it, try another model. Ideally, you will be able to try out the machine before you buy it, but at least try one from the same manufacturer. Make sure you can return it within a reasonable time period if it is not satisfactory. Measure out the space you have set aside for it before you go shopping for a machine, or you may have an unpleasant surprise when it is delivered.

Some newer types of machines use different types of resistance. Bowflex uses special rods, Soloflex uses rubber straps, and Total Gym uses your own body weight in a clever way. These, while not cheap, have the advantage of being much lighter and more portable than weight stack machines. You can store your Bowflex in a closet and wheel it out to the patio to work out outdoors, for instance. These machines are sold mostly through mail order, so may be difficult to try out before buying, although you should be able to return them if they are not satisfactory. Get the manufacturer to send you all the relevant information before deciding on one of these.

On the top end, if you are a very advanced weight trainee or bodybuilder who wants to work out at home, your best bet is to get a power rack and Olympic bar and plates, plus dumbbells. This may require you to set aside a room or garage for your home gym. (A power rack is a rectangular “cage”device with pins and supports that will catch the bar if you cannot complete your lift. This, or something similar, is necessary for safety if you are going to do heavy lifting without a spotter. You also have to learn how to set the pins and dump the bar safely.)

If you have the space, it’s nice to have a rack or tree for your dumbbells and plates. Get a piece of cardio equipment that you like. If you want to do cardio elsewhere, you can warm up for weight training by walking or jogging a bit, going up and down stairs, or jumping rope. A mat for your stretching gives you the extra comfort you deserve at the end of a hard workout.

If this seems subjective, it’s because it is. Fibromyalgia is a collection of symptoms, not a specific disease. This has led some skeptics to wonder if it really exists. This is a significant question, because an estimated two percent of the U.S. population is thought to suffer from fibromyalgia, with women seven times more likely than men to have it.

Common complaints of “fibros” (people with fibromyalgia) are chronic achiness, morning stiffness and sleep disturbance. But those are common complaints of a lot of people.

Exercise helps improve the symptoms, but fibros are reluctant to exercise because of the pain. However, pain typically shows up one to three days later, not during exercise. This is also common in people starting exercise programs, especially if they are out of shape, and most fibros are in rotten shape.

Weighing in on the side of organic problems are recent studies indicating fibros are deficient in growth hormone or insulin-like growth factor, IGF-1, indicating hormonal dysfunction. This seems to be tied into the problem of sleep disturbance and non-restorative sleep. So far this knowledge has not led to effective treatment. Most fibros use some sort of alternative medicine, which indicates that conventional treatments don’t work.

And what about the most popular type of conventional medicine — drugs? Some fibros are helped by antidepressants, but just as many respond to a placebo drug.

Someone from the Arthritis Foundation told me that there is a theory that men have fibromyalgia almost as much as women; they just drink their way through it. I hasten to add that this in no way is meant to reflect the position of the Arthritis Foundation or the person who told me about it.

Fibromyalgia is lumped in with arthritis, so the Foundation knows a lot about it. The representative was just giving me an example of the theories that abound. I passed this along to a chiropractor friend who said in no way did men have fibromyalgia in as any numbers, because the people who came to see him with that complaint were all women. He missed the point, which is that men are reluctant to seek treatment for this condition (according to this theory). And health professionals do have their stereotypes about fibromyalgia, which is too bad, because they don’t seem to be able to help much with what they know.

Anything that’s diagnosed by excluding other diseases is bound to be questioned. The pivotal 18 tender points may be tender on healthy people. We just don’t test them out if we feel good. (This is not tenderness to touch. It is tenderness to 10 pounds of pressure. Try it out.)

Even if this collection of symptoms masquerading as a disease is not caused by bacteria or hormonal dysfunction or genetics, apparently it really does hurt. In time, more will be known about fibromyalgia, and treatments will become available. If you have this condition, don’t sit around and wait for that time. Get somebody who is expert in exercise to help you with a workout program and get as fit as you can. That will help.

Finally, as she hangs up the phone, the pharmacist notices that one of the patients is arguing with the clerk about his insurance co-pay. Why is it $25 and not $15? The pharmacist walks past your almost-ready prescriptions to explain to the angry man the pharmacy has no idea what co-pays are for any given plan. That knowledge is the responsibility of the patient. All information is entered into the pharmacy computer, sent immediately to the insurance company and they send back the co-pay information. This is true for all insurance plans. He pays, but goes away mad, sure that the pharmacy is trying to “steal even more of his money!”

The pharmacist heads back to the counter and finally gets to check your prescriptions. There are no problems and they are ready to go. Now, just as she is ready to explain the medication to you the phone rings and as all the technicians are helping others, she must answer the phone. It is a patient calling in seven refills, all of which they would like to pick up in about an hour. Would that be possible?

At last the pharmacist is able to counsel you about your prescriptions and then turns you over to the clerk to check you out. Whew!

Unfortunately that scenario is all too common these days in the pharmacy business. It continues all day long and has become a source of great frustration for both the patients and the pharmacy staff. What was not mentioned above is that for every prescription filled in that scenario, the insurance company paid the pharmacy $4 (on average … sometimes it is less than that) over and above the cost of the medication.

Now you can see why a pharmacy must do great volumes of prescriptions to be able to repurchase the medications used, pay the staff, the bills, etc. Now you can see why, as much as all of us behind the counter try to make sure no mistakes are made, errors do occur. Now you can see why, as much as all of us behind the counter try to make your wait as short as possible, circumstances often prolong that time. Now you can see why, as much as all of us behind the counter would like to spend more time making sure you understand everything, we just don’t have the time we wish we did.

Is there anything you as a patient can do to help make your wait shorter and reduce the chances that a medication error could be made on your medicine?

There are a few things to keep in mind.

You are responsible for your insurance information.

Always carry your card with you and be aware of your co-pays. The pharmacy has no way to know what your particular plan offers and cannot reduce your co-pay if it has increased. If you have a problem or don’t understand why your co-pays went up you need to call customer service at your insurance company for the answers. If you have a new insurance plan, be sure to give the information to the staff before they even start filling your prescription. That will speed up the process considerably.

Always call in regular refill medications several days before you need it and give the pharmacy some idea of when you are going to pick them up.

This is helpful in case you are out of refills and the doctor’s office must be contacted, if the medicine is out of stock, etc. Never take the last pill and then call in the refill and expect it ready in an hour. That puts undo pressure on everyone.

If your pharmacy offers a drive-up window, please try to use it only for drop-off and pick-up.

Don’t ask the pharmacy staff to get you some aspirin. If you need to shop, come into the store. Also, don’t bring five new prescriptions to the window and then wait for them in your car. This just ties up the window, not allowing others to pick up their medications.

Whenever possible, don’t call in routine refills on Mondays.

The volume of prescriptions is always greatest on Mondays, and that always increases the risk of a medication error being made.

To make your wait shorter, try to avoid coming to the pharmacy between 11 a.m. and 1 pm and 4 p.m. and 5:30 p.m.

Many people think they will just “drop by” the pharmacy and get a refill, pick up medications, ask a question, whatever, and find that they have a long wait, which is frustrating. These are very popular times for doctor’s offices to make their daily call-ins to the pharmacy, which ties up the pharmacy staff, as well as times that many people are out running errands.

If you call the pharmacy with a question for the pharmacist and you are told he or she is busy, rather than waiting on hold, offer to leave your phone number.

The pharmacist is usually glad to call you back and talk to you when things are less hectic. This gives them a chance to give their full attention to you.

If you have called your doctor and requested a medication be called in, be patient.

They need time to talk to the doctor, call the pharmacy and we need time to get the prescription processed. Many people show up 30 minutes after talking to the doctor’s office expecting their medication to be ready. It just doesn’t work that way. And please, don’t ask the pharmacy to call the doctor’s office for you when you find out the prescription is not ready.

If the medication you received looks different than it has before, never take it without calling the pharmacy.

Chances are that if it is a generic medication the pharmacy just used a different brand, but there is always the chance that an error was made. A good pharmacist is never unwilling to double check the medication to make sure is correct.

So, now you have been behind the counter. It is a hectic world that will only grow busier as the number of prescriptions written continues to increase. Hopefully this will give you some idea of what it takes to get a prescription from the doctor’s pen to your medicine bottle as quickly and error-free as possible.

I am a pharmacist. I work in a small independent store. Although I have not worked in a large chain pharmacy, I can tell you from talking with many other pharmacists that as a profession our problems and concerns are all pretty much the same. In a small pharmacy we do have a bit more of a chance to talk to our patients than our large-chain counterparts, but not much more. Almost every pharmacist I know would like to be doing a better job under better circumstances.

The first thing many people may not understand is the function of the people behind the counter. There are usually three types of people in a pharmacy: the pharmacists, the pharmacy technicians and the clerks. The technician can answer the phone, take refills, enter prescriptions into the computer and count the medications. They will alert the pharmacist if the computer flags any potential drug interactions or other problems; in the end of the process it must be the pharmacist who checks the prescription before it is dispensed. That is the law. Technicians can also help patients find over-the-counter items; help solve insurance problems, put away drug orders etc. In any given day, they will do all of those things, often interrupting one task to do another.

Clerks are usually support staff there to run the register, stock over-the-counter medications, answer the phone and be a liaison between the patient and the pharmacy staff. They can’t answer medical questions but can refer you to the pharmacist for the answer.

The pharmacist is the person most in demand. We are required by law to be there for the store to be open. No medication can be dispensed unless a pharmacist has checked it. We are required to counsel any patient that does not refuse the counseling. We take phone-in prescriptions from doctor’s offices. We must be constantly on the lookout for fraudulent prescriptions, which is a big problem. We answer patient questions over the phone and in the store. We recommend over-the-counter remedies for all kinds of ailments. We often have to handle insurance problems: drug changes due to formularies, drugs not covered by certain plans, refills too soon, etc. When medications are unavailable due to manufacturing problems we must find suitable alternatives. (In some stores, pharmacists even run blood pressure checks, blood glucose monitoring clinics, and administer flu shots.)

All of these functions and more are routine work for the pharmacist and usually more than one thing must be done at a time to try to keep the work moving at the pace demanded by today’s patients. It is very common for a pharmacist to only get to go to the restroom once or twice in a 10-hour shift and to never get a break to eat. If we get to eat at all, it is a bite between phone calls or checking prescriptions. In smaller independent stores, this is also true for the technicians.

So, now you know a bit about the function of the people you see behind the counter. Let’s now look at filling some prescriptions that you just brought from your doctor’s office for the terrible cough and fever you have. Your doctor was running an hour behind and now you are anxious to get your prescription filled and get home to fix dinner. It’s 4:30 in the afternoon when you arrive at the pharmacy and present your prescriptions to the clerk. Several people are already milling about, obviously waiting also. You are told it will be a bit, as there are several people in front of you.

The prescriptions you have handed in are given to the technician. They are read for patient name, drug name, quantity of drug and any obvious errors. They are then entered into your profile on the computer where the drug interaction programs look for any problems between the medications you already take and the new ones just prescribed.

The computer has spotted a drug interaction, so the technician must wait for the pharmacist to evaluate the potential problem before they can continue. Work on your prescription has just stopped. The pharmacist is checking several prescriptions for a person who was waiting there before you. She will look at the computer in just a moment. In the meantime another technician has answered the phone and there is a patient on the line who wants to ask a question. They will hold until the pharmacist is available. A second line rings and it is a doctor’s office needing to phone in a prescription. They will hold until the pharmacist is available. Your prescription is still waiting on the computer. The pharmacist takes the call from the doctor’s office.

The technician has the next set of prescriptions ready for the pharmacist to check. After doing that, the pharmacist is able to glance at the computer and must make a quick judgment about the potential interaction. Deciding there won’t be a problem she tells the technician to continue filling. Finally yours is being worked on again! After getting all of your prescriptions entered into the computer and through your insurance, the technician informs the pharmacist that your prescriptions are ready to be checked. The pharmacist nods, as she is now on the phone with the person who had called with a question. She will get to yours in a moment.

..to continue see post II

“The radiologist wants a follow-up mammogram in six months,” your doctor tells you.

You’ve heard and seen all the TV and Radio ads about 1 in 8 women getting breast cancer. So, you’ve been good–you got screened. Now you have to do it all over again?

As it turns out, the mammogram is difficult to interpret due to “dense glandular tissue,” a very common finding in younger women or those on HRT.

And that’s when you realize that not knowing whether you have a tumor or not is one of the most trying experiences of your life.

You don’t have a tumor, but you know lots of women get breast cancer. You’re scared but as far as anyone can tell there really is nothing wrong with you, so why talk to anyone about it? It’s enough to make you a nervous wreck.

Your doctor reassures you, quoting statistics about screening and telling you that “this is just a standard practice–there is no indication of tumor.” But somehow the prospect of bad news lingers in the back of your mind.

Doctors know that repeated mammography may pose a risk of cumulative radiation exposure, yet the risks of missing a tumor far outweigh this. But now there is a way to reduce the number of mammograms some women receive due to dense glandular tissue.

And a more definitive answer to “that question” may make quite a few patients feel much better.

Why is “dense glandular tissue” a problem? Conventional x-rays (a mammogram is a low-radation x-ray) are not the best way to view soft tissue changes. It is ironic that x-rays are used to diagnose breast cancer because a small tumor inside dense glandular tissue cannot be seen.

This is why you may see radiologists constantly and tediously poring over mammograms with magnifying glasses. They do their best not to miss anything.

If there is a finding of “dense glandular tissue” and the radiologist cannot rule out a tumor (she can’t rule out what she can’t see) the best course in the past has been to follow the patient with a repeat mammogram in 6 months, usually, or sometimes 12 months so the radiologist can compare the series of mammograms to see if there any changes.

A recent study of 196 women shows that MRI (Magnetic Resonance Imaging) can be used to rule out suspicious-looking mammograms. The benefit to the patient is that she doesn’t have to worry for 6 months, waiting for her “follow-up.”

One of the big pay-offs of using MRI is that there is no radiation used in the procedure. MRI uses radio-frequency magnetic pulses that have not yet been demonstrated to have any ill effects. In addition, MRI is considered much better than other radiographic procedures in imaging soft tissue such as fat, glands, muscle and ligaments.

Luckily, there are methods that can be used to handle problems and make it more manageable.

What Is the Origin Of This?

Weak pelvic muscles usually exist in women who have this desease. When there are weak muscles, they make the urethra, the tube that releases urine, to fall downward, which results in urine spilling out. Two issues that result in a weakened pelvic floor in females who have urinary incontinence are having a baby and being overweight. Females who have had babies have a greater risk of getting urinary stress incontinence in contrast to females who don’t have any children; plus the more children that a woman has, the greater chance she has of ending up with this problem. Being overweight also puts extra stress on the pelvic floor making it weaker.

How Is This Identified?
Typically symptoms makes it easy to diagnose. If the diagnosis is unsure, the doctor might do a bladder stress test. This is done by a fluid injection in the bladder. The women is then instructed to cough and urine dripping is looked for. It is also necessary to have an urinalysis done to make sure that a urinary tract infection is not causing the symptoms.

The pelvis should be looked at to see if an enlarged uterus or ovaries are putting extra stress on the pelvic floor.

Easy Lifestyle Modifications

Frequently, simple lifestyle modifications can be very helpful in bladder controll. If being overweight contributes to this issue, losing weight could help you. One experiment conducted revealed that women who reduced their weight by three pounds decreased their amount of leakage by 32%. The outcome was even more amazing when they lost more weight.

Total avoidance of caffeine also helps the symptoms for some females. Women can also teach themselves to urinate every hour so their bladders will remain as empty as possible.

Constipation could also be part of the problem, so a diet with more fiber is something that definitely is necessary.

More Treatments

An additional worthwhile method to handle urinary stress incontinence is to make the pelvic floor muscles stronger. This is accomplished with Kegel exercises. This includes squeezing the vaginal muscles and holding them at ten second intervals a few times daily. Directions showing how to do it can be located online. This plan can require time to see results – typically four to seven months. With bad cases of stress urinary incontinence, prescribed medications might be taken. Yuo can purchase Bladder Control Natural Supplement Pills online.

online.

During the initial stages of a romance, e-mail becomes both a blessing and a curse. E-mail flirtations increase in frequency, and the infatuated recipient can mull incessantly over every abbreviation and bit of punctuation. Phraseology can prompt tortured late-night conversations with empathetic friends, analyzing the minutiae of flirtatious e-mail etiquette. When he opened his note with the line “Hey there cutie” did it mean anything special—or is he just a player? When he ended his note with a nonchalant “see you later” was it a profession of his true love, or a casual blow-off? Why didn’t he sign his name at the end of the message? What is the deeper meaning behind his punctuation, capitalization, and abbreviation? What about “e-motions,” those little smiley faces of all sorts?

My friend Katherine engaged in such tortured over-analysis when she and her current boyfriend, Ryan, began the dance of e-mail flirtation. Ryan jotted and mailed to Katherine an inspired poem containing references to both microeconomic theory and brazen behaviors. She attempted to decode his hidden messages. For the rest of the semester, nightly e-mail conversations ensued between the microeconomics homework partners. A year later, written flirtations and hilarious semi-tawdry exchanges led the way to an actual romance. Partially, thanks to e-mail, Katherine and Ryan have been dating happily for a year.

More than written flirtations, e-mail also encourages the exchange of little gifts. In the age of mp3s and picture sharing, e-mail provides a medium for testing the waters of new relationships with cost-free presents. Before we considered ourselves a couple, my boyfriend Brian and I engaged in little exchanges. Upon the receipt of the Eagles’ “Witchy Woman” my roommates declared that the romance was dead based upon the secret message Brian must have intended when sending me that song! Yet a month later, Brian sent me a photograph of a dozen roses for Valentine’s Day … followed by the biggest teddy bear I had ever seen. E-mail and real life melded perfectly, and the relationship is going strong to this day.

But real life and “e-life” don’t always work together so nicely. While e-mail can provide a safe medium for flirtation, a crucial element of communication is lost when human emotions are translated into computer code. A warm smile and enthusiastic intonation can’t really be captured in characters on a screen, and panic can creep into a relationship if messages change in style or decrease in frequency.

As a friend Rajiv shared, “let’s just say that technology not only brings people together … but it has also reduced the time required to break people apart.” Other friends concur: “E-mail seems to be a way for some guys to get OUT of actually talking to you about how they feel—kind of hiding behind the computer screen.” Face-to-face confrontation becomes unnecessary when the computer provides an easy escape.

But let’s assume you’ve made it past the tricky initial stages of a relationship and have entered the land of couplehood. What role does e-mail play in long-term relationships?

The Long Term Relationship

What might a long-term couple say about the wonders and drawbacks of e-mail in their relationship?

Katherine insists that in the age of e-mail the seriousness of commitment is gauged by one thing: passwords. “Couplehood” often entails shared e-mail passwords. “In its own silly way, sharing passwords can prompt feelings of intimacy and trust,” believes Katherine.

However, a deteriorating relationship can be harmed with something as small as a password change. Rob asked his new fling Liz not to e-mail him, because his girlfriend Leslie had his password; meanwhile, Liz felt hurt because a no-email policy seemed to be Rob’s attempt to squelch their relationship. On campuses all across America, scenes like this are reenacted every day as e-mail gains even greater stature.

Still, for some couples e-mail benefits can be great. Kirsten insists that e-mail allows her to share feelings with her boyfriend of almost two years, Abe. “Sometimes I can write about my feelings better than I talk about them. E-mail has let me share some important things with Abe that I might not have been able to say to his face.”

@mixedmessages.com

So where does this leave us? Does e-mail lead to over-analysis of the details of budding romances? Or does it prompt us to be more introspective and really understand what a person wants from a relationship?

In reality, e-mail’s biggest problem is that it is so neutral. Humans are complicated creatures who add emotional baggage and secret messages to a technical stream of computer code. What we need to remember is e-mail’s neutrality. Instead of becoming caught up in decoding the hidden intent behind a message, let’s step back from the keyboard and remember the depth and complexity of real human relationships.

The art of the letter may be dead, but any college student will assure you that the art of the e-mail is alive and well. For college students, the importance of e-mail extends beyond its ability to request eleventh-hour paper extensions from professors or send quick notes to friends. E-mail has changed the way we look at romantic relationships. For better or for worse, “will he call” has turned into “will he e-mail?” and the old-fashioned request for someone’s phone number has likely transformed into a request for an e-mail address. “Is that @aol.com?” has become a familiar refrain at pickup scenes.

College romantic relationships and e-mailing are inextricable intertwined. E-mail offers convenience, informality, and a medium to test gingerly the potential interest of that special someone. The cute guy in finance class is accessible … via e-mail. Dash off a few carefully crafted lines with just the right proportions of warm wit and casual coolness, run to class, and wait to gauge the response. Will he respond? He does. Now the message must be interpreted. A reply must be fashioned. The pattern continues. Perhaps a relationship blossoms, or maybe a fling ensues, or a brush-off two-line reply will end the affair. But no matter what the outcome, at every turn—from initial dainty steps into flirtation, to joined-at-the-hip relationships—e-mail adds a new dimension to the dance of romance.

Let’s examine “e-mail as enabler” as it relates to flings, budding romances, long-term relationships. Sit down, cozy up with a cup of tea, and prepare to recognize and analyze the quirky ways that technology has influenced each of our love lives!

The Fling

Looking for a safe flirtation? Oh the joys of e-mail! From behind the flicker of the computer screen and with the confidence of a 3 a.m. caffeine or alcohol infusion, a degree of boldness can develop when addressing the object of romantic interest. Take my friend Alice* whose bold two-line message to a future boyfriend has become the stuff of Dartmouth legend. “I’m bored. Wanna hook up?” Would Alice have said such a brazen thing while in the physical presence of her future beau? Most likely not. However, e-mail emboldens. Alice’s gumption reaped success: thanks to the face-saving technique called e-mail, she could “joke” about her true intention. If he had responded negatively she could have played the message as a joke—but given his enthusiastic agreement, she was able to proceed with her plans.

However, e-mail has its darker side. The morning after meeting someone at a party, a newly infatuated college student can crouch in front of the computer, agonized by an empty in-box. Similarly, many a student has found fingers paralyzed over the keyboard while trying to remember an e-mail address mumbled in haste and haze from that previous night’s fling.

E-mail can enable bold flirtation, but it can also prompt heart palpitations from anxiety. What about the next stage, a budding romance? More excitement and more anxiety await.